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Appendix J1 1 Blood-borne Pathogen Exposure Source Risk Assessment, MMC Healthcare Worker Exposure Date & Time: Name of Exposed Healthcare Worker Initials and location of Source patient EXPOSURE TO
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01
Gather the necessary materials, such as personal protective equipment (PPE), a clean surface to work on, and the bloodborne pathogen exposure source form.
02
Put on PPE to protect yourself from potential exposure to bloodborne pathogens.
03
Place the bloodborne pathogen exposure source form on a clean surface.
04
Fill out the form accurately and completely, providing all the required information.
05
Provide details about the incident, including the specific exposure source, time, and location.
06
Include information about the individuals involved, such as their names, job titles, and contact information.
07
Describe the circumstances of the exposure, including how it occurred and any contributing factors.
08
Indicate if any medical treatment or testing was provided as a result of the exposure.
09
Verify and sign the form to certify the accuracy of the information provided.
10
Submit the completed bloodborne pathogen exposure source form to the appropriate authority or department.

Who needs bloodborne pathogen exposure source?

01
Any individual who has been exposed to blood or other potentially infectious materials (OPIM) in the workplace needs a bloodborne pathogen exposure source form.
02
This includes healthcare workers, laboratory personnel, emergency responders, and anyone else at risk of occupational exposure to bloodborne pathogens.
03
Employers may require their employees to fill out this form to comply with safety regulations and track incidents of exposure.
04
Additionally, individuals seeking medical treatment or testing as a result of a bloodborne pathogen exposure may need to provide this form to healthcare providers.
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Bloodborne pathogen exposure source refers to any potential source of infection that could lead to the transmission of bloodborne pathogens.
Employers in specific industries where there is a risk of exposure to bloodborne pathogens are required to file bloodborne pathogen exposure source.
Bloodborne pathogen exposure source can be filled out by documenting all potential sources of exposure in the workplace and implementing measures to control the risk.
The purpose of bloodborne pathogen exposure source is to identify and mitigate potential sources of exposure to bloodborne pathogens in the workplace.
Information such as the type of exposure, date of exposure, and steps taken to address the exposure must be reported on bloodborne pathogen exposure source.
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